Reflections of a Dietetic Intern Through the Inaugural WVU ISPP Class

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Amyotrophic lateral sclerosis (ALS), also known as “Lou Gehrig’s Disease,” is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. Motor neurons reach from the brain to the spinal cord and from the spinal cord to the muscles throughout the body. The progressive degeneration of the motor neurons in ALS eventually leads to their death. When the motor neurons die, the ability of the brain to initiate and control muscle movement is lost. With voluntary muscle action progressively affected, patients in the later stages of the disease may become totally paralyzed.

There is early evidence from a small study that people with ALS who are fed a high-kcal, high-carb diet, could potentially see the progression of their disease slowed.
Patients with ALS, who have difficulty swallowing, as did the 24 people in this study, often end up requiring a feeding tube into the stomach in order to receive the adequate amount of nutrition. These patients are usually fed a standard commercially available formula. ALS patient lose weight because they are not able to take in enough calories because of their difficulty in swallowing. As patients lose weight, they are actually burning their own muscle.

Researchers found that a high-kcal, high-carb tube-fed diet was safe and tolerated- better than one designed to main weight or a diet high in fat. Patients on the high-kcal, high-carb diet gained some of the weight they had lost. At the very least, patients should avoid losing weight.

There needs to be larger trials to see if patients should be trying to gain weight. But, until this happens, all patients with ALS should be actively avoiding losing weight.
This study was published in February 2014 and experts report that the results are far from definitive. This study is also much too small to really show a survival benefit from the diets described. A larger trial would be needed to really highlight any problems. Overall, the study, and future studies, would be beneficial if it included more patients.

The sigmoid colon is the terminal section of your large intestines that attaches to the rectum and anus — a sigmoid colectomy is a surgical procedure in which the sigmoid colon is resected. During this procedure, the sigmoid colon is removed and the remaining large intestine is then reattached to the rectum. After the procedure, patients will need to eat certain foods to allow the intestines to heal, as well as to prevent gastrointestinal upset such as diarrhea, constipation and excessive gas.

Patients should follow a low-fiber diet for about six weeks after discharged from the hospital. A low-fiber diet is imperative for post-colectomy patients to decrease the risk of trauma to the intestines and promote healing. After six weeks, slowly introduce fiber back into your diet. Patients can then increase fiber intake by only one serving each day, until they are able to tolerate 20 grams to 35 grams per day, or about five servings. Patients should be sure to drink plenty of water while increasing your fiber. Fiber can be constipating when not complemented with adequate water.

I recently led a follow-up appointment with a patient who was on his third chemotherapy treatment and recovering from a sigmoid colectomy. The patient consistently lost 14 pounds over the last 6 months but gained 10 pounds since his last appointment, which was last month. But, the patient reported that he was slowly gaining his appetite back but could not tolerate smells like he used to. On the SOAP (subjective, objective, assessment, plan) note I developed, I indicated that I educated the patient on the importance of keeping his weight up and maintaining that weight as well. It’s important for patients to maintain their weight after major surgeries like a sigmoid colectomy, in addition to cancer treatment. The stronger the state that the body is in, the more tolerable it will be towards the treatment of cancer. The patient is currently prescribed a vanilla-flavored supplement from the facility and reported that he couldn’t tolerate the taste of it sometimes. So, I educated him on different ways to make his supplement taste better like adding chopped strawberries to his supplement. We talked about what foods he could eat and how we were going to make sure that the patient listens to his body. By listening to his body, I mean if a patient can tolerate a certain food on a Monday- then eat it. But if he can’t tolerate that same food on Tuesday- try something different. The patient reported that he “forces himself to eat”, which is good for patients going through chemotherapy. A number of patients that are going through chemotherapy become easily frustrated. But, RDs are there to remind them that they need to fight through the frustration and aggravation of their senses (taste and smell specifically) changing.

In the recent news of New Jersey’s Governor Chris Christie’s efforts to lose weight, it’s important for people everywhere to really understand the extent of a lap-band surgery. So far the New Jersey native has lost 40 pounds. But, it’s important to keep in mind, after having major surgery like this, that maintaining weight loss will be attributable to adopting a healthy diet and lifestyle. Here are some diet tips to follow after lap-band surgery:

–Eat small portions

oLimiting portion sizes is essential to patients after having surgery. A lap-band surgery decreases the size of your stomach and could even make it painful to consume large quantities of food. It is recommended that patient also eat slowly and chew their food thoroughly to avoid discomfort.

–Focus on high protein foods

oProteins provide a sense of satiety and fullness. But, focusing on soft proteins is important after surgery. Some examples of soft proteins are Greek yogurt, low-sodium soups, or cottage cheese.

–Avoid drinking and eating at the same time

oAvoiding the consumption of drinking and eating at the same time is one of the most important rules to follow post-surgery. Staying hydrated is very important as well. So patients should stop drinking at least 10 minutes before eating and then avoid drinking at least 45 minutes after finishing a meal. The main concern here is to prevent vomiting from occurring.

–Limit pasta, rice, and bread

o Since eating fiber is healthy for people without surgery, it is not suggested that it should be avoided completely. Most patients simply do not tolerate pastas and bread products because they absorb fluids and expand. These types of foods can make patients feel uncomfortable and too full.

–Consume soft fruits and vegetables

oIn the first few weeks post-surgery, patients will need to puree fruits and vegetables. Later these patients can introduce whole fruits and vegetables. The skins of fruits and vegetables (like apple skins or cucumber skins).

The main message that people should know is that lap-band surgery is a tool to maintain weight in patients. The surgery is not a quick-fix or a solution. It is only efficient if the patient is aware of what they’re putting in their stomach and how much of it as well.

This past week, I had yet another Extended Community Action Team meeting. Within this meeting, I have 3 undergraduates on my Action Team. They each represent a different aspect of community nutrition off-campus in the Morgantown, WV surrounding area. One of those interns is responsible for community nutrition education at the Shack Neighborhood House. Since we instilled a rainbow nutrition curriculum last semester, I wanted to try something a little different.

I remembered a show that Rachel Ray hosted, where she would travel the country and try different foods and restaurants based on that region and she was on a budget. So, since the ISPP Dietetic Interns most recently were solely responsible for a successful food culture nutrition and culinary education class… I thought this could be like a food culture program but, only within the US. So, out came the new nutrition education curriculum called “Our Healthy Roadtrip”. Each week, for 6 weeks, students from the Human Nutrition & Foods department at West Virginia University will educate children in grades 3-5 on different food culture based on different regions of the country. Then, they will focus on one specific food and have a snack and interactive activity corresponding with the curriculum. This new program starts on March 4th and will continue until mid-April. I think the students at the Shack Neighborhood House will really get a better sense of the country and what it has to offer, in regards to nutrition and food culture as a whole.

The location of our new nutrition education curriculum!

A poster I created that will be on display at the SNH for the remainder of the programming!

Shingles, also known as herpes zoster, is a viral infection that causes a rash that can be painful. According to MayoClinic.com, shingles typically resolves on its own, but medications can help hustle up the healing process and relieve pain. Certain nutrients have displayed pain-relieving assets, and incorporating these into your diet can help with shingles or painful difficulties.

First

Add foods to your diet that are rich in lysine. Or you can take a lysine supplement. Lysine is an amino acid that may prevent herpes virus outbreaks, says the University of Maryland Medical Center. Dietary sources of this amino acid include meat, cheese, sardines, eggs, soybeans, beans and legumes. Fenugreek seed is also a good source of lysine.

Second

Eat shellfish, eggs, beef and dairy products, all of which contain vitamin B-12.

Stock up on foods high in vitamin C and zinc. MayoClinic.com states that shingles outbreaks can occur due to an impaired immune system, and vitamin C and zinc are essential in promoting a healthy immune system. Good sources of vitamin C include oranges, strawberries, broccoli, leafy greens, peppers and potatoes. Oysters, red meats, chicken, legumes and whole grains are also good sources of zinc.

What to Avoid when you have Shingles

Shingles

According to the Mayo Clinic, shingles are red, raw and very painful blisters that can appear anywhere on your body but typically appear as blisters that wrap around your torso. If you have previously had chicken pox, are over 50 and have a weakened immune system, you are most at risk for contracting shingles. The CDC advises you to stay away from infants, pregnant women and others who have compromised immune systems until your shingles outbreak has passed.

Foods to Avoid

Avoiding certain foods can help alleviate symptoms of shingles. Arginine is an amino acid that your body produces naturally, but you should avoid foods that contain it. Arginine helps the herpes zoster virus to replicate. Chocolate, nuts and gelatin contain high levels of arginine. Also, don’t consume foods such as saturated fats or refined carbohydrates, because those might cause further inflammation. In addition, avoid alcohol and caffeine because these can weaken the immune system.

So, recently one of my Dad’s best friends (which means he’s referred to as an Uncle), was diagnosed with stage 2 Prostate Cancer. So, naturally this was pretty hard news to handle, especially being so close to this family friend. I started looking into more information on the specific cancer and these are some things that I found…

Prostate cancer is a malignant tumor in the prostate, the male gland that produces fluid that makes up part of the semen. The prostate gland is about the size of a walnut. It is attached to the bottom of the bladder and surrounds the urethra. The growth and function of the prostate are controlled by male hormones, like testosterone. Prostate cancer is often slow-growing, and is sometimes present for years before symptoms appear. The five-year survival rate for patients with early diagnosis and treatment is close to 100%.

Prostate Cancer is the most common cancer among men in the United States after skin cancer. More than 200,000 new cases occur annually. It is the second leading cause of cancer deaths in men, after lung cancer. Roughly, 27,000 deaths are attributed to prostate cancer each year.

The cause of Prostate Cancer varies. A man’s age, ethnicity, and family history are all risk factors that cannot be changed. Research is underway to clarify how risk linked to hormone levels, including testosterone and insulin-like growth factor (IGF), may be changeable. Current research suggests that you can reduce your chances of developing prostate cancer by making healthy dietary choices.

Making diet and lifestyle changes can reduce your risk of cancer. Research shows that eating a mostly plant-based diet, maintaining a healthy weight, and getting regular physical activity lowers risk of prostate and other cancers.

Experts suggest that some food choices may be linked to prostate cancer. Foods that probably offer protection against prostate cancer include:

Foods containing lycopene, an antioxidant. Lycopene is most commonly found in tomatoes and tomato products, and fruits like red or pink grapefruit, watermelon, and guava.

Foods high in calcium. However, as the evidence of cancer risk and diets containing cow’s milk, cheese, and other foods high in calcium seems to be in conflict with findings on other types of cancer, there is no recommendation to change how much you consume.